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Refugee Children's Participation in the Women, Infants, and Children Supplemental Nutrition (WIC) Program in Massachusetts, 1998-2010

Smock, Laura MPH; Nguyen, Thinh; Metallinos-Katsaras, Elizabeth PhD, RD; Magge, Hema MD, MS; Cochran, Jennifer MPH; Geltman, Paul L. MD, MPH

Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue 1 - p 69–77
doi: 10.1097/PHH.0000000000000789
Research Reports: Research Full Report
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Objectives: To (1) describe prevalence of growth abnormalities and anemia in refugee children; (2) describe the proportion of age-eligible refugee children enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and (3) identify risk factors for lack of enrollment in WIC.

Design: Data were collected from 1731 health screenings for refugee children younger than 5 years in Massachusetts in 1998-2010 and matched to WIC program records. Risk factors for lack of WIC enrollment were analyzed in SAS using multivariate logistic regression.

Setting: Massachusetts.

Participants: Refugee children under age 5 years.

Main Outcome Measures: (1) prevalence of growth abnormalities and anemia in refugee children, (2) proportion of age-eligible refugee children enrolled in WIC, and (3) association of risk factors with lack of WIC enrollment.

Results: Overall, 33% of refugee children under age 5 in Massachusetts had at least 1 growth and nutrition problem, including anemia (31%), stunting (10%), wasting (8%), and low weight for age (10%). WIC enrollment among refugee children under 5 years of age was only 62%, lower than that of all eligible children under 5 in Massachusetts (86%). Risk factors for lack of WIC enrollment among refugee children included age, world region of origin, and arrival cohort.

Conclusions: Although many refugee children under age 5 experience growth or nutrition problems, one-third of refugee children in Massachusetts were not enrolled in WIC for nutrition assistance, representing a failure of the system. Agencies providing services at the local level should be supported to facilitate enrollment and participation for shared clients.

Division of Global Populations and Infectious Disease Prevention (Mss Smock, Nguyen, and Cochran, and Dr and Geltman) and Division of Nutrition (Dr Metallinos-Katsaras), Massachusetts Department of Public Health, Boston; and Department of Nutrition, School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts (Dr Metallinos-Katsaras); Institute for Healthcare Improvement, Brigham and Women's Hospital Division of Global Health Equity, Boston Children's Hospital Division of General Pediatrics, Boston, Massachusetts (Dr Magge); and Ambulatory Care Services, Franciscan Children's Hospital, Boston, Massachusetts (Dr Geltman).

Correspondence: Laura Smock, MPH, Division of Global Populations and Infectious Disease Prevention, Massachusetts Department of Public Health, Boston, MA 02130 (laura.smock@state.ma.us).

The authors thank Rachel Colchamiro, Jane Dvorak, and Judy Hause from the Massachusetts WIC Program for their collaboration on this project. This project was supported by a grant from the Centers for Disease Control and Prevention, Strengthening Surveillance for Diseases Among Newly-Arrived Immigrants and Refugees (CDC-RFA-CK12-1205; J. Cochran, PI).

The authors declare no conflicts of interest.

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